MEDICARE: CHICAGO BEHAVIOR CONSULTANTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor
3	104100000X	Social Worker
4	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0001673723	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1235146374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO BEHAVIOR CONSULTANTS, INC.

Provider Business Mailing Address
First Line	:	1458 W BRYN MAWR AVE
Second Line	:	SUITE 2
City	:	CHICAGO
State	:	IL
Zip	:	60660-4225
Country	:	US
Telephone Number	:	773-654-3484
Fax Number	:	773-654-3484

Provider Business Practice Location Address
First Line	:	655 W IRVING PARK RD
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60613-3123
Country	:	US
Telephone Number	:	773-654-3484
Fax Number	:	773-654-3484

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. JAMES L. LAWYER
Credential	:	LCSW
Telephone Number	:	773-654-3484

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/08/2013

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Directions to “CHICAGO BEHAVIOR CONSULTANTS, INC. ” Practice Location

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